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Inspection on 02/06/06 for Better Care Residential home

Also see our care home review for Better Care Residential home for more information

This inspection was carried out on 2nd June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users within the home remain positive about the care that they receive at the home. The inspector had the opportunity to talk to three of the four service users currently living at the home. Comments received from two of the service users were `I feel safe here and that means a lot to me` and `I like being here, I`m looked after by the staff`. Five relatives/friends responded to the questionnaire and again they were no comments that caused any concerns.Service users spoken to at the time of the inspection all felt that they were generally involved in making decisions on a day to day basis, the examples given were what to eat, what toiletries they wanted to buy for themselves.

What has improved since the last inspection?

The last two inspections had identified issues regarding medication, namely omissions in the Medication Administration Records (MAR) on two occasions; and changing the G.P`s instructions on the dosage and frequency of the medication, on one occasion. This area has improved slowly over the period, and at this inspection no errors were found in the administration of medication. No requirements have therefore been made in this area. A further area that has seen improvement over the period of the last two inspections is that of recording. Although there are still significant areas of improvement to be made in this area, the recording is generally now up to date and appears to be more accurate. Care plans are now reviewed on a regular basis and this was with service users who sign the document to confirm that they are in agreement with the plans.

What the care home could do better:

There has been an ongoing issues regarding staffing at this home. Registration was only granted on the basis that two members of staff were on duty at all times. The previous inspection again raised this as an issue as only one member of staff was on duty at any one time. The agreement had been that the Commission would consider a review of these staffing levels at less busy times once they had received documentation from the proprietor that service users were in appropriate work or education.This documentation has still not been forthcoming. At the last inspection one service users stated that she `had to go out when she did not necessarily want to, as there was only one member of staff on duty and that service users could not be left in the home unattended.` At this inspection when asked service users could all give examples of such situations arising. It appears that this situation happens on average on a fortnightly basis. This is a restriction on freedom of choice and must be addressed immediately. The manager has stated that there are contingency plans for emergencies such as sickness, however, this need to be stated clearly in writing to the Commission. The need for this was further emphasised following an incident, which occurred, on the 21.12.05 when one of the service users attacked the member of staff with a knife, and the police had to be called. In summary, the lack of adequate staffing, compromises the freedom of choice of service users, puts service users and staff at risk and finally the excessive hours worked by could affect the care provided by staff. There is also an issue regarding training within the home. The manager has initiated her NVQ Level 4 in March. However, there is little evidence that any other appropriate training has been offered by the home. One member of staff has stated that she has done vulnerable adults training, although there is no evidence of this. The Care Standards Act 2000, state that each member of staff should have a individual training and development assessment and at least five days training per year (pro rata), this is clearly not happening.

CARE HOME ADULTS 18-65 Better Care Residential home 211 Brighton Road Purley Surrey CR8 4HF Lead Inspector Ms Rin Saimbi Key Unannounced Inspection 2nd June 2006 09:15 Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Better Care Residential home Address 211 Brighton Road Purley Surrey CR8 4HF 0208 763 9796 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Agnes Harriette Lucinda Coker Mrs Agnes Harriette Lucinda Coker Care Home 4 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (4) of places Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The undersized bedroom will be used as a communal space, with the existing dining room becoming a bedroom. The French windows out of the upstairs bedroom will be permanently locked with ventilation being provided by other means. 1st December 2005 Date of last inspection Brief Description of the Service: Bettercare is a registered care home for up to four female service users who have mental health difficulties. The homes aim is to provide rehabilitation and support to enable service users to develop skills for independent living. The home itself is a large Victorian property situated on a busy road near Purley. The home is close to local shops and has good transport links via buses and trains. The home is a converted residential property and from the outside appears to be no different from any of the other properties on the road. The homes accommodation is over two floors; the ground floor has a communal lounge/dining room, it is also been used as a temporary office with a filing cabinet, there is a kitchen, bedroom and toilet. The first floor has a further three bedrooms, bathroom and a storage area. To the rear of the property there is a garden with a small patio and lawned area; to the front of the building there is driveway, which could accommodate several cars. The costs of a placement per week for the year 2006/07 are £500. Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the home’s first inspection for the year 2006/07, it was an unannounced key inspection. The inspection itself started at 9.15 and lasted approximately five hours. The inspection took the form of discussions with three of the four service users, the manager, who was only available for half an hour due to prior commitments, and one member of staff who currently works twelve hours per week. In addition, there was a tour of the building and looking through documentation at the home, which related to service users and staff. Various documentation received by the Commission for Social Care Inspection since the last inspection was also considered. This included five responses received by the Commission to questionnaires sent out to relatives and friends. No issues were raised from these responses. In addition, the Commission received a letter from the Fire department on the 22nd March 2006, which outlined four failures to comply with the relevant legislation. It appears that three of the four elements have been dealt with, and that the body of this report will highlight the remaining element. The inspector would like to thank the service users, manager and staff member who cooperative with the inspection process, to the best of their ability. What the service does well: Service users within the home remain positive about the care that they receive at the home. The inspector had the opportunity to talk to three of the four service users currently living at the home. Comments received from two of the service users were ‘I feel safe here and that means a lot to me’ and ‘I like being here, I’m looked after by the staff’. Five relatives/friends responded to the questionnaire and again they were no comments that caused any concerns. Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 6 Service users spoken to at the time of the inspection all felt that they were generally involved in making decisions on a day to day basis, the examples given were what to eat, what toiletries they wanted to buy for themselves. What has improved since the last inspection? What they could do better: There has been an ongoing issues regarding staffing at this home. Registration was only granted on the basis that two members of staff were on duty at all times. The previous inspection again raised this as an issue as only one member of staff was on duty at any one time. The agreement had been that the Commission would consider a review of these staffing levels at less busy times once they had received documentation from the proprietor that service users were in appropriate work or education. Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 7 This documentation has still not been forthcoming. At the last inspection one service users stated that she ‘had to go out when she did not necessarily want to, as there was only one member of staff on duty and that service users could not be left in the home unattended.’ At this inspection when asked service users could all give examples of such situations arising. It appears that this situation happens on average on a fortnightly basis. This is a restriction on freedom of choice and must be addressed immediately. The manager has stated that there are contingency plans for emergencies such as sickness, however, this need to be stated clearly in writing to the Commission. The need for this was further emphasised following an incident, which occurred, on the 21.12.05 when one of the service users attacked the member of staff with a knife, and the police had to be called. In summary, the lack of adequate staffing, compromises the freedom of choice of service users, puts service users and staff at risk and finally the excessive hours worked by could affect the care provided by staff. There is also an issue regarding training within the home. The manager has initiated her NVQ Level 4 in March. However, there is little evidence that any other appropriate training has been offered by the home. One member of staff has stated that she has done vulnerable adults training, although there is no evidence of this. The Care Standards Act 2000, state that each member of staff should have a individual training and development assessment and at least five days training per year (pro rata), this is clearly not happening. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home has gathered some information regarding service users, generally this information is pertinent. Therefore to some extent service users receive their assessed care needs. However, this information is lacking in detail and is based solely on the judgement of the manager/proprietor. The fact a decision is made by one individual could impact upon the care that is provided to the service users. EVIDENCE: Pre-admission assessment information was available for service users with current identified problems and service users psychiatric history. Information from this assessment process was then at the initial stages translated into the care plan, which was completed in conjunction with the service users themselves. A previous requirement had been made that all prospective service users must have all areas of need and risk identified prior to admission to enable the home to make decisions about the ability of the home to meet needs. The home has had one new admission since the previous inspection in December 2005. The documentation was viewed for the new service user; it Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 10 consisted of a double-sided sheet of paper entitled the ‘Pre-admission assessment’. The information was basic, it included personal details, risk assessment and medication. It did not include the fact that the service users does not eat beef, which may have been for religious reasons, however, the inspector was unable to confirm this. Within the file there was no evidence of other professionals assessment having been obtained. The manager stated, that other professionals were not forthcoming with assessments. It must be noted that the ‘pre-admission assessment’ is completed by the manager/proprietor, who although is a nurse does not have specific qualifications in mental health, although she does have experience in this area. It is therefore unclear, how the judgement is made regarding a placement, as there is no written available evidence for the service user who was admitted most recently. Therefore, a requirement remains that the home must have their needs fully assessed prior to the admission of any new service users by people competent to do so. Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In general the quality of information held about service users was pertinent and generally should assist staff to ensure service users are as independent as possible. Staff must ensure the safekeeping of service users files to ensure that service users confidentially is not compromised. EVIDENCE: The service users within the home all had a written care plan. It was noted at the previous inspection that there had been an improvement regarding documentation for service users, this has remained the case. Two of the four service users files were viewed; risk assessments were in place; both had a service user plan, which was reviewed on a monthly basis and signed by the service users themselves. Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 12 In discussion with the service users themselves, they were able to state that they had seen their own care plans and that they were reviewed with the manager on a regular basis. Two requirements have therefore been withdrawn regarding care plans. Firstly, that they should be kept up to date and changes are recorded accordingly. Secondly, that the care plans must be completed with the service users. Service users themselves felt that they could take control of their lives on a day-to-day basis and that they were supported in doing this by the home’s staff. With regard to the issue of confidentiality, the member of staff spoken to at the time of the inspection had an understanding of the issues surrounding confidentially. However, the concern is that service users files are not stored away appropriately; rather the lounge/dining room also combines as an office. There is a four-drawer filing cabinet, and on the day of inspection service user files were on the chair. Therefore, making them available to anyone in the dining room. A requirement has therefore been made that service users files must be locked away when not in use. Secondly, that the filing cabinet must be removed from the lounge/dining room. Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In general, service users within the home are encouraged to live ordinary and meaningful lives. Their lifestyle aspirations vary according to their interests and there is some opportunity for personal development and independence training. EVIDENCE: The homes stated aim is provide rehabilitation and support to enable service users to develop skills for independent living. Service users appear to have good community links; on the day of inspection one of the service users was attending a craft class and would then be visiting her mother; one was out shopping and making preparations for her imminent move into her own independent flat; one service user was likely to meeting her boyfriend; and one was in bed Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 14 In addition, service users spoke of various other activities that they attended, this included college courses. The manager spoke of her plans to try and get service users involved in voluntary work and to this end there had been an arrangement for someone from the volunteer beaux to talk to the service users that day. Unfortunately, it had been cancelled due to the workers sickness. There were also holidays and trips arranged; all four of the service users went to Broadstairs in Kent for a four-day trip recently. One of the service users stated that they also had recent trips to Sutton for shopping and Crystal Palace. One service user stated that she did not really make the decision about outings and trips, rather they ‘just came about’. An example given by the member of staff, was when recently the home had been watching a programme about Windsor, when the manager said’ who would like to go there?’ Service users were able to confirm that friends and family were welcome to visit whenever they wished, and that there was also more formal invites such as the Christmas party. Three of the four service users regularly attended church, they do not need assist with this and therefore are able to go whenever they wish. With regard to meals and meal times, service users spoke positively about the food. The service users decide upon a menu and then will assist in the shopping and preparation of the food. The home is able to cater for one service a user who is vegetarian, she stated she is provided with food that appropriate. One of the service users does not eat beef, the inspector was unable to confirm if this was for religious reasons, as the information was not recorded anywhere. During the period of the inspection, no meals were observed being prepared by the service users, however, the lunchtime meal was burger and chips; menus were available and seemed to contain a variety of fresh foods and convenience foods. Fresh fruit is available and service users are able to help themselves to drinks and snacks. Service users nutritional needs are assessed and their weight monitored, on a regular basis, if required. One service user is clinically obese and therefore her weight is monitored and the home are trying to educate her regarding the most appropriate foods to eat; the documentation relating to weight was up to date. Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are encouraged to take as much responsibility as possible for their own health and personal care needs. This is crucial for the service users who have been discharged from hospitals and are in the process of moving towards independence and autonomy. EVIDENCE: Service users are generally given opportunity to maximise choice; in general they manage and hold their own money. Service users are able to choose their own clothes, toiletries, make their own hairdressing appointments. The service users were able to confirm that they are treated with privacy and dignity; staff always knock on their bedroom doors; their mail is always received unopened; there is a communal telephone available in the hallway, in addition if service users have a private call then the home will let service users use the portable handset which can be taken into their bedrooms. Service users are encouraged to maintain their own health appointments, this is seen as essential by the home as part of a process towards independence Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 16 and autonomy. Staff will accompany service users only if necessary, on the day of the inspection a member of staff was due to accompany a service user to a hospital appointment. The home does keep a record of all appointments that they are informed of; documentation in relation to this was viewed for two of the service users. The information appears to be recorded, albeit in a rather ad hoc manner on a piece of paper. Service users have absolute choice about which health professionals they wish to register with, NHS healthcare is local and can be accessed easily. The home monitors service users mental health and will make referrals if it becomes appropriate. A multi-disciplinary team review and monitor medication at a day centre. All service users attend the centre unaccompanied, at which time they are given two weeks prescribed medication. This, the manager explained was to encourage independence and responsibility. The manager then hand transcribes the medication information from the container onto the Medication administration sheet. Medication is stored away in a metal cupboard, which is locked. The previous inspection identified one requirement with regard to medication; that is to say that Medication Administration Records (MAR) must be completed in full. This had been a requirement of the previous two inspections, however, at this inspection no omissions were observed and therefore this requirement has now been withdrawn. Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a complaints policy in place, which should ensure that service users feel that they are listened to. The home has acquired some policies and procedures regarding vulnerable adults, however, the extent of knowledge within the staff group and the levels of training remain of concern, and it does not ensure that service users would not be protected from abuse. EVIDENCE: The home has a complaints policy in place, it previously did not cover all the elements required by the standards, namely the timescales. there is now a policy in place, which has been adapted from another home, however it is adequate and meets the required elements within the standards. Therefore the requirement has therefore been withdrawn. Neither the home nor the Commission have received any complaints from service users or any other interested parties. Service users in general felt that their views were listened to, although as with the last inspection, all service users stated that if they had an issue regarding their care they would raise it with their care managers in the first instance. Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 18 The home has not yet acquired Croydon’s policy and procedures regarding vulnerable adults; this is an outstanding requirement since 22/6/05. The home has acquired some policies and procedures regarding vulnerable adults and therefore this previous requirement is withdrawn. The manager stated previously that she has not undertaken any training in the area of vulnerable adults. One member of staff had undertaken training independently of the home in September 2005. However, this could not be verified at that time, nor has it been since the last inspection, with a certificate of attendance. The remaining member of staff was asked a question of serious abuse and was able to give a basis response. This combination of factors is of concern to the Commission and must be addressed for with. Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is on a residential road and from the outside appears no different from the other properties. The home is accessible to community facilities and services and meets the service users needs EVIDENCE: The home is located on a busy residential road on the outskirts of Purley. The accommodation is over two floors; on the ground floor there is a large lounge/dining room, one bedroom, and a large kitchen with access to the garden. The second floor comprises of a further three bedrooms, bathroom and storage room. The home is equipped with domestic style furniture and benefits from certain areas having recently been painted. There are sufficient communal areas, which can be accessed by service users freely. On the ground floor there is a lounge/dining room. Located near the dining area there is also a four-drawer filing cabinet and all the files relating to the service users and the running of the home. The dining room table is used as a Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 20 desk. The inspector was previously informed by the manager, that this was only a temporary measure, and that they office would be relocated into the small bedroom. As previously highlighted in the report, files not being appropriately stored away compromises the confidentiality of the service users. In addition, the use of the lounge/dining room as an office space, effectively restricts the communal area for the use of service users. A requirement is therefore being made in regard to this. Each of the service users has their own bedrooms, which are equipped with a bed, wardrobe, chest of drawers and wash hand basin. It is the responsibility of the service users themselves to tidy their own bedrooms as part of their programme towards independence. All bedrooms were clean and relatively tidy. Each bedroom has a lockable door and only they and the manager have key. The previous inspection identified one bedroom that did not have a serviceable lock for some considerable time. This has now been rectified and therefore this requirement has been withdrawn. It was noted that not all service users had a lockable drawer or space in their bedroom, this was identified as a requirement at the last inspection and has not been actioned, and therefore a requirement remains in this regard. There has been an ongoing issue regarding clutter within the home, at the last inspection, which was an announced inspection this requirement was withdrawn. However, the home has become somewhat cluttered and untidy again. This detracts from the home having a comfortable and homely atmosphere, but also more importantly, from a safety point of view. The following areas need to be freed from clutter; planks of wood from the garden; piles of ironing in the kitchen; ladders and dirty rags from the hallway. Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Insufficient staffing levels and the lack of staff training does compromise service users safety, independence and freedom of choice. EVIDENCE: There remains an ongoing issue between the Commission and the manager/proprietor of the home regarding the levels of staffing. Registration was granted on the basis that two members of staff were on duty at all times. The agreement had been that the Commission would consider a review of these staffing levels at less busy times once they had received documentation from the proprietor that service users were in appropriate work or education. This documentation has still not been forthcoming, and has in fact been a requirement since the last inspection in December 2005. At the last inspection, one service users said that she ‘had to go out when she did not want to, as there was only one member of staff on duty and that service users could not be left in the home unattended.’ Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 22 At this inspection when asked there were several examples given of times when service users had had to go out when they did not want to. This is a restriction on freedom of choice. The Commission will be addressing these issues directly with the proprietor/manager. The home is reliant on very few staff that work in isolation. It appears that the proprietor/manager and one other staff member work in excess of 100 hours per week. A third member of staff works twelve hours per week. Whilst both full time members of staff have signed the exception to the European working time directive, the fact remains that the excessive number of hours could compromise the safety and well being of the service users. The inspector was informed of an incident when a service user became disruptive and violent and pulled a knife on a member of staff. The police were called and the service user removed, the member of staff incurred a minor injury and was treated the next morning. This again emphasis’ the need to have contingency plans in place should an emergency arise, A requirement therefore remains that the home must provide a written submission to the Commission outlining what activities are currently undertaken by the service users on a regular basis; highlighting what contingencies plans are in place for any emergency and how the home will ensure that there is no service users restriction of choice There is also an issue regarding training of staff within the home; the manager has initiated her NVQ Level 4, however, there is little evidence that any other appropriate training has been offered by the home. One member of staff at the previous inspection stated that she has done vulnerable adults training although there was no evidence of this. The Care Standards Act 2000 states that staff must have the knowledge and experience of specific conditions of service users to enable them to work effectively. This is clearly not occurring in this home, as one member of staff has only completed fire training. In discussions with the member of staff on duty, she has been in post for some 18 months and works twelve hours per week; so far completed some fire training. The Care Standards Act 2000 state that staff should have an individual training and development profile, and at least 5 days training (pro rota). This is clearly not the case in this situation. Staff do receive supervision and support in order to carry out their tasks; supervision occurs on a regular basis and is recorded and signed by both parties. A member of staff on duty confirmed this via written documentation and. Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 23 The staff team consist of three individuals; one Black/African women; one mixed/S. American and one white/British women. Three of the service users within the home are white/British and one is an Asian women. Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41 and 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although management of the home ensures the day-to-day running of the home, the quality of the care that service users receive could be compromised by the lapses in administration. EVIDENCE: The registered manager of the home and has a qualification in nursing, although not in the field of psychiatry. The manager has started her NVQ Level 4 in March 2006 with ‘Edexcel’ and hopes to have it completed within a year. There are some quality assurance and monitoring systems in place, for example service users do have a regular meeting. However, the home has never provided details of a Regulation 26 visit, nor did the home provide the Commission with details of the incident, at the time, Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 25 relating to the police being called to the premises, this is in line with Regulation 37. A requirement is therefore being made in regard to both the above. In regard to health, safety and welfare of the service users, a number of issues were identified during a tour of the building. Fire doors must be kept closed and not propped open, this was a requirement from the previous inspection and was highlighted by the fire department at their recent inspection. Food stored in the kitchen must be kept in the original containers or must include the expiry date. Food stored in the refrigerator must be dated with the date of opening, and thrown away at the appropriate time. A valid Certificate of Employers Liability was available and due to run out on 9/8/06; PAT stickers were seen on appliances dated 9/5/05; there was evidence of fire evacuations having taken place on a regular basis. Gas installation checks were not available for inspection on the day of the visit and therefore a requirement was made a recent copy be sent to the Commission. A copy of work completed by British Gas was forthcoming which was dated prior to the inspection having taken place. In addition, the First Aid boxes were checked and found to contain many out of date items, these included swabs dated 2001/04 and sterile dressings dated 2003/01. Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 1 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 2 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 X 2 X X 1 x Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 27 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA2 Regulation 14(1)(a) & (b) 17(1)(b) 12(1)(a) Requirement Timescale for action 02/06/06 2 3 YA10 YA23 New service users are only admitted on the basis of a full assessment undertaken by people competent to do so. Service users records are kept in 02/06/06 a secure and confidential manner The home must obtain Croydon’s 02/07/06 policies and procedures regarding vulnerable adults Outstanding requirement from 22/06/05 Clutter must be removed from certain areas in the home a) Ladders and rags removed from the hallway b) Planks of wood removed from the garden c) Piles of ironing to be removed from the kitchen The home must ensure that service users have a lockable space in their bedrooms Outstanding requirement from 1/12/05 The four drawer cabinet must be removed from the lounge/dining room; and the practice of using the dining area as the office DS0000055368.V296002.R01.S.doc 4 YA24 12(2)(d) 02/07/06 5 YA26 23(2)(m) 02/07/06 6 YA24 23(2)(a) 02/08/06 Better Care Residential home Version 5.2 Page 28 must cease 7 YA33 18(1)(a) The home must provide a written 16/06/06 submission regarding staffing levels, outlining the activities that service users attend on a regular basis and contingency plans if there is an emergency and an assurance that service users freedom of choice is not compromised Outstanding requirement from 22/06/05 Staff must receive training in order to fulfil the needs of the service users, in particular mental health Outstanding requirement from 01/12/05 The manager must complete her NVQ Level 4 8 YA35 18(1)(a) 02/09/06 9 YA37 9(2)(b)(i) 02/09/06 10 YA39 26 11 YA39 37(1)(e) 12 YA42 23(4)(a) Outstanding requirement from 22/06/05 The registered provider must 02/09/06 ensure that visits are conducted on a monthly basis in compliance with Regulation 26, and that a copy of their report is submitted to the Commission The home must ensure that the 02/06/06 Commission is informed of any events that adversely affect the well-being and safety of service users Fire doors must be kept closed at 02/06/06 all times Outstanding requirement from 01/12/05 The home must take the following action to ensure the health and safety of the service users a) Food removed from its original container must be dated accordingly DS0000055368.V296002.R01.S.doc 13 YA42 12(1)(a) 02/06/06 Better Care Residential home Version 5.2 Page 29 b) Out of date food must be disposed of c) Evidence must be provided of regular gas servicing d) Items stored in the First Aid boxes must be checked regularly to ensure that they do not contain out of date items RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Better Care Residential home DS0000055368.V296002.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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